脑室-腹腔分流术治疗新生儿先天性脑积水的疗效观察

目的观察脑室-腹腔分流术(VPS)治疗新生儿先天性脑积水的疗效。方法回顾性纳入2017年1月至2020年6月郑州大学第三附属医院神经外科采用VPS治疗新生儿先天性脑积水患者,共98例。患儿产前均经超声和胎儿MRI诊断为胎儿脑积水,产后第1天行头颅CT确诊为新生儿脑积水[侧脑室体部宽度(LVW)>10 mm],结合脑室径/双顶间径(V/BP,>0.25为脑积水)判断脑积水的严重程度;均于出生后1个月内行VPS。术后1年,复查头颅CT评估LVW、V/BP改善情况,采用Gecell发育量表评估患儿的发育情况。结果98例患儿均手术成功,VPS后11例(11.2%)患儿发生皮下隧道感染,7例(7.1%)发生分流管感染,14例(14.3%)发生脑脊液感染,5例(5.1%)发生分流管堵塞,1例(1.0%)发生分流管断裂。术后1年,98例患儿的LVW、V/BP分别为(15.3±6.5)mm、0.27±0.08,与术前的(33.3±9.4)mm、0.39±0.12比较,差异均有统计学意义(均P<0.01);其中77例(78.6%)患儿LVW较术前减小,21例(21.4%)较术前改善不明显或增大。Gecell发育量表评估显示,74例(75.5%)发育符合月龄,24例(24.5%)发育不符合月龄,其中16例(16.3%)轻度落后,8例(8.2%)中重度落后。头颅CT评估LVW与Gecell发育量表评估符合者共87例(88.8%),不符合者11例(11.2%)。结论分娩后早期手术治疗新生儿先天性脑积水疗效较好,疗效评估要结合影像学改变及发育情况等指标进行综合评估。

Observation on the effect of ventriculoperitoneal shunt in the treatment of neonatal congenital hydrocephalus

Objective To observe the efficacy of early ventriculoperitoneal shunt(VPS)in the treatment of neonatal congenital hydrocephalus.Methods A retrospective analysis was conducted on 98 cases of neonatal congenital hydrocephalus treated by VPS in the Department of Neurosurgery of the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2020.The diagnosis of fetal hydrocephalus was made by ultrasound and fetal MRI before delivery,and neonatal hydrocephalus was diagnosed by head CT on the first day after delivery[lateral ventricle body width(LVW)>10 mm],combined with ventricular diameter/biparietal diameter(V/BP,>0.25 for hydrocephalus)to judge the severity of hydrocephalus.VPS was performed within 1 month after birth.One year after the operation,the head CT was rechecked to assess the improvement of LVW and V/BP,and the Gecell Developmental Scale was used to assess the development of the child.Results All 98 children underwent successful operations.After VPS,11 cases(11.2%)had subcutaneous tunnel infection,7 cases(7.1%)had shunt infection,14 cases(14.3%)had cerebrospinal fluid infection,and 5 cases(5.1%)had blockage of the shunt,and shunt rupture occurred in 1 case(1.0%).One year after the operation,the LVW and V/BP of 98 children were 15.3±6.5 mm and 0.27±0.08 respectively,which were significantly different compared with preoperative values(33.3±9.4 mm and 0.39±0.12)(both P<0.01).In this series,77 cases(78.6%)of the children had a decrease in LVW compared with preoperative conditions,and 21 cases(21.4%)had little improvement or an increase in LVW compared with preoperative conditions.The evaluation based on Gecell Developmental Scale showed that 74 cases(75.5%)developed in line with the age of the month,24 cases(24.5%)did not meet the age of the month,of which 16 cases(16.3%)were slightly behind,and 8 cases(8.2%)were moderately or severely behind.In a total of 87 cases(88.8%),the assessment result through LVW on skull CT was concordant with that using Gecell Developmental Scale,while those were not concordant in 11 cases(11.2%).Conclusions Early surgery after delivery has a good efficacy in the treatment of neonatal congenital hydrocephalus,and the comprehensive evaluation of the therapeutic effect should include imaging changes and developmental indicators.